Impact of Adopting a Multidisciplinary Care Delivery Model on Treatment Effectiveness and Outcomes in Stage III Melanoma Patients at a Community-Based Academic Institution: A Retrospective Study

TL;DR

A multidisciplinary care model improved survival and reduced recurrence in stage III melanoma patients at a community-based academic institution.

Contribution

Demonstrates the effectiveness of a multidisciplinary care model in improving outcomes for stage III melanoma patients.

Findings

Three-year disease-free survival increased by 30% after implementing the multidisciplinary care model.

Melanoma-related mortality decreased by 30% in the post-implementation cohort.

Early use of PD-1 immunotherapy and nurse navigation were key factors in improved outcomes.

Abstract

Purpose

Stage III melanoma represents a high-risk patient population, highlighting the need to implement strategies to prevent the onset of metastatic disease. This study evaluates the impact of systems of care, incorporating multidisciplinary care (MDC), nurse navigation, clinical trials, and early anti-PD1 immunotherapy use, on outcomes for this patient population.

Patients and methods

We conducted a retrospective chart review to evaluate the impact of an updated melanoma MDC program implemented at our institution in late 2016. This program facilitated access to nurse navigation, along with early PD-1 immunotherapy use and clinical trial enrollment, with the expectation of improved outcomes for our melanoma patients. Data were collected from 121 stage III melanoma patients treated at our institution between 2014 and 2019, divided into two cohorts: 2014-2016 (n = 66) and 2017-2019 (n = 55). Primary outcomes included three-year disease-free survival (DFS) and overall survival (OS). Secondary outcomes included disease recurrence rates and melanoma-related mortality.

Results

Implementation of an MDC model led to a significant increase in immunotherapy use, multidisciplinary visits, and nurse navigation. These combined factors resulted in a 30% increase in three-year DFS (from 48% to 78%, p = 0.001) and a 17% increase in three-year OS (from 63% to 80%, p = 0.04). There was a 30% decrease in stage III melanoma mortality (39% vs. 9%, p < 0.001).

Conclusion

Systematic sub-specialized care, nurse navigation, access to clinical trials, MDC care, and rapid adoption of advancements in the standard of care led to improved patient outcomes at our institution.

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